Dysuria is the term for painful urination and can vary from mild discomfort to a burning sensation or severe pain when urinating. The pain may be felt in the bladder or urethra during urination or could extend across the entire perineum. It is not uncommon for the pain to persist throughout the day and exacerbate upon urination. Dysuria often results in hesitancy as a person is anxious to commence with voiding due to the prospect of pain upon urination.
Causes of Dysuria
The pain upon urination is usually due to inflammation of the urethra and/or bladder. In most cases, this is due to infections of the genitourinary system and is commonly accompanied by other symptoms like urging, incontinence, hematuria, cloudy urine and fever. Discharge may also be present and could related to a sexually transmitted diseases (STD’s).
Non-infectious causes of dysuria may be acute or chronic in nature. Apart from inflammatory disorders of the urinary tract, there may be inflammation of surrounding structures in the perineum, including the prostate (men), vagina, cervix or uterus (women) or colon. Pain extending from the upper abdomen may indicate renal (kidney) causes of dysuria which is commonly associated with kidney stones.
Infectious Causes of Dysuria
Bacterial causes are by far the most common infectious cause of dysuria and the infection progresses rapidly. Protozoal and fungal infections also need to be considered but the onset of symptoms due to infection by these microorganisms may be more gradual. Parasitic infections like schistosomiasis (bilharzia) are a common cause of dysuria in endemic areas.
- Cervicitis (cervix)
- Often due to a sexually transmitted disease (STD).
- Cervical discharge may be present.
- Cystitis (bladder)
- Constant dull ache in the perineum, aggravated by bending forward.
- Tenderness over the region of the bladder upon applying pressure.
- Frequent urination and urging along with changes in the urine (blood in the urine, cloudy urine, foamy urine and/or strong smelling urine).
- Epididymo-orchitis (testes, duct)
- Swelling and tenderness of the testes and tubules leading to the vas deferens.
- Hematospermia (blood in the semen) may be evident.
- Pain upon intercourse, ejaculation.
- Prostatitis (prostate gland)
- Prostate enlargement and tenderness.
- Hesitancy, straining and/or dribbling may be present.
- Urging and frequent urination.
- Urethritis (urethra)
- Often related to sexually transmitted infections.
- Offensive smelling discharge and itching of the external genitalia.
- Visible swelling of the penis may be evident in men.
- Dyspareunia (pain upon intercourse) may be more pronounced in men with urethritis.
- Vulvovaginitis (vulva, vagina)
- Offensive smelling vaginal discharge often present.
- Swelling and redness the vulva/labia may be evident.
- Itching of the vulva/vagina.
- Pain upon intercourse may also occur along with slight bleeding after intercourse (post-coital) which is not related to menses.
Non-Infectious Causes of Dysuria
- Allergic reaction to latex condoms, lubricants, spermicides, soap, toilet paper, tampons and sanitary pads.
- Benign prostatic hyperplasia (men).
- Urinary stones.
- Foreign body in the bladder, urethra.
- Interstitial cystitis.
- Atrophic urethritis particularly in post menopausal women.
- Urethral stricture.
- Dehydration resulting in concentrated urine which irritates the urethra.
- Drugs like NSAID’s, gout medication, steroid drugs, chemotherapeutic agents.
- Radiation treatment (radiation cystitis).
- Sexual abuse often accompanied by swelling and pain of the vulva (vulvitis).
- Spondyloarthropathies like reactive arthritis (Reiter’s syndrome), Bechet’s syndome.
- Tumors of the bladder, prostate (men). Rectal cancer, uterine and ovarian cancer should also be considered either due to pressure on the bladder or secondary spread (metastases).